VentMedic

Just your foot?

Did they get this blood from an NG tube? Did they place it in the ED or did the patient already have one? Or was this a suction catheter that someone tried to clear the airway by NT suctioning?

Forget the INR thing or what the RNs did or didn't do for now and get back to the ABCs. Both of these calls are good learning experiences for your own knowledge and you will run into these situations again in less controlled environments. When did the patient stop breathing? Were you assisting the patient's respirations? Did either you or your partner initiate CPR? That will sometimes attract the attention of others. What treatment did you do enroute to the hospital? What were the last set of vitals? How long did it take you to go from the dialysis center to the ED? Would this patient have benefited from a Paramedic transport?

Syncope? Define "unresponsive". That could mean many things especially for a patient in the NH. Was he not able to speak but awake? Was it just a blank stare? Unresponsive to what type of stimuli? The fact that the patient has A-Fib may or may not be pertinent depending on whether it is controlled. I know a co-worker who has had A-Fib since he was 25 y/o (20 years ago) after a bacterial infection and sometimes forgets to list it on his medical hx. For the dialysis patient, you had a critical patient on your stretcher and YOU didn't call the ED to announce you were on your way? I think I would seek out a better way to communicate with this ED rather than just standing there screaming. Why would they even have compressed air in a dialyis center or flow meters that run on compressed air? Did you at least switch them over to O2? What care did you provide to the patient on the way to the ED? Let's have a better and more productive discussion focusing on what you could do for each of these patients or what you might have done differently.

The comments at the end of the article have some good and some not so good points. http://www.naplesnews.com/news/2009/aug/25...tion-25-parame/ COLLIER COUNTY — Twenty-five North Naples firefighters are no longer allowed to work as paramedics because they haven’t met training requirements set by Collier County Medical Director Dr. Bob Tober. North Naples Fire Chief Orly Stolts said the move puts good medics out of commission and endangers residents. “What he’s done is minimized the fire department’s ability to save lives,” Stolts said of Tober. “We’re going to have to stand there and wait to give life-saving medication until an ambulance arrives at the scene. That puts our guys in a pretty hard spot.” But Tober said he’s actually protecting those residents. He said the 25 firefighters who haven’t met advance life support requirements can still provide basic life support — using defibrillators, administering oxygen, taking blood pressure and setting up intravenous lines. “It goes without saying that I would do nothing to threaten the public,” Tober said. “As a matter of fact, everything I do is to protect the public.” In an Aug. 19 letter to Stolts, Collier County EMS Chief Jeff Page identified 19 North Naples firefighters who have not complied with a February “ride time” mandate that requires each of the county’s firefighter-paramedics to work at least one 24-hour shift on an ambulance every quarter. Stolts said arranging to have his firefighters pulled from an engine once a month causes significant scheduling and overtime difficulties. Six other firefighter didn’t have the proper training records on file, according to the letter. Stolts said those six firefighters have been working under Tober since 2006, but haven’t yet met new training requirements. “They understood this clearly. They didn’t meet the directive,” Tober said of the firefighters. “I think they just assumed I wrote the requirements that I wasn’t going to enforce.” Stolts said Tober has decertified about half of the paramedics. “We’re down to 17 paramedics that ride the trucks now,” he said. “Four or five a shift is all we have left.” Tober has been in an ongoing feud with several Collier County fire departments for years. Most recently he accused North Naples and East Naples firefighters of cheating on a protocols test. However, the state Department of Health declined to investigate Tober’s complaint, saying it was legally insufficient.

Sometimes I like reading Nevius' opinions and sometimes they are just off base and often for some of his own politically based agenda. He is a sensationalist. He also fails to mention this guy's real psychological and medical issues. So keep in mind this article is largely opinion and not necessaily based on investigative reporting. You can see some of his other interests: http://www.sfgate.com/columnists/nevius/archive/ This was yesterday's article about the same "drunk". Drunk collared yet again, this time for threats http://www.sfgate.com/cgi-bin/article.cgi?.../BA5M19D2OM.DTL This is Nevius' real issue and not alcoholics abusing the ambulances. Whereas this should be the issue: For those who have never hear of Niels Tangherlini: http://www.emsnetwork.org/artman2/publish/...ter_25052.shtml

That is changing since RT has made the 2 year degree officially their minimum entry level requirement and the weeding out of those who didn't want to upgrade has removed the slackers out of the critical care areas. This is much like what happened to the LVNs who had worked in the hosptials. They were given several years notice that things were changing and their options were clear. Rid and I have had this discussion many times since when he had worked in the hospital, RTs were only OJTs. That is also how I started over 25 years ago when I didn't want to do another 24 hour shift on a fire truck for extra money. Now that there is a Bill for RTs with a Bachelors to move into another environment and reimbursement opportunities, that will bring about even more changes in attitude. Some of the older RNs do remember what they went through when they were "just diploma" nurses and that was their entry level of education. Of course in the 1970s, many of the allied health professions did not exist or were just OJT techs. RNs were still in charge of all. Things change as medicine and technology changes. RNs are feeling the level of their own education requirements being scrutinized and it is even more evident in the multidisciplinary meetings. For even my own degree at a Masters level on my tag I feel a little under educated at times with the PTs, OTs, and SLPs around me. It has been a good incentive to advance my own education. RNs are finding themselves working for unit managers who are not RNs. RNs who had fought the BSN are now also going back to school. It is usually the ones who work only in one area of the hospital and see an allied health provider do only one task. RNs that have never worked in the critical care areas, where the majority of RT work is done, will probably not see an RT do much except O2 rounds on the floors which is still a decent revenue producer as usually the RT department carries the cost of that big liquid O2 tank outside the hospital on their budget. If the RNs don't go to the HBO or Cath Lab Center, they again will not see what RTs do. The same for Radiology. If all the RN sees is someone pushing a big machine for an X-Ray and have never been down to IR or involved in therapeutic radiation, they don't know what these professionals do. However, it is no different than what some in EMS believe for RNs. They may only see an RN start IVs in the ED and ask the doctor what's next and may not know their 2 volumes of protocols and procedures exist. As well, if the EMT(P) has never stepped foot inside a progressive ICU or seen a Rapid Response Team work on a patient, they may think the RNs are pretty worthless and must call for every order. Nothing could be further from the truth. Again, the EMT(P)s measure worth by "skills" so it doesn't matter if an RN can do many "critical care" things, if they don't intubate in the ICU they are considered inferior to an EMT(P) by some in EMS. Some even believe the RN and even the RRT must sit through a Paramedic class to get the intubation skill. What they don't realize is how many healthcare providers do have intubation in their scope of practice by the state if there is a need for it. In the hospitals, skills are viewed a little differently. Doing "just intubation" is not going to get you that much respect since some RTs have been intubating since back in the 70s as OJT techs. If it is a complex set of "skills" that requires additional education such as specialty transport, ECMO, CVVH, VADs etc, then that is viewed at a different level. Knowing ACLS in itself is also a fundamental requirment for many ICU RNs and treated as an expectation and nothing special. Infact, knowing the many protocols such as Sepsis, ARDS, etc is more along the lines of critical care. Phlebotomy is a skill. It is viewed as a needed skill but not necessary one that requires much education, except now entry level phlebotomists are now nationally and state certified. If someone is seen doing phlebotomy the "skill" few will recognize that the person might be a MLT with 6 years of colloege.

You've chosen a relatively new profession with RT as it has only started ot make serious advances with licensure in the 1980s. Few also know what RTs actually do or the opportunities for them. Few monitor their legislation or know where they stand in the whole health care realm. Few know about th e Bachelors and Masters degree for RT and the beneifts both will bring once a couple of Bills are passed. A few believe if they can put albuterol in a nebulizer they are at the same level as an RT. Physical Therapy (as well as OT and SLP) is one porfession that I like to use as a very well paid and highly educated profession that doesn't need alot of visibility or TV shows to prove their value to anyone. Like many of the allied health professions, they get their satisfaction from their patients and other members of their team. Again, some may think if they walk a patient down the hall they are just the same as a Physical Therapist. Nothing could be further from the truth if you ever read their charting. Radiology is another allied health profession that few realize the depth of study it requires. The specialities it also involves not only for the different technology but also for the many different age groups is pretty amazing. Interventional and therapeutic Radiology Technicians are highly respected by the doctors who work with them and the patients that need their expertise. Nuclear Medicine Technician is another growing professional that has gained rapid growth in education and pay. Again, this is a relatively new profession. Medical Lab Technologists who have up to Doctorate levels are another profession few understand. Many just think they draw blood. So again, some Paramedics believe if they put some blood in a tube while doing an IV they are doing the same "skill" and that makes them just the same. EMT(P)s often measure the worth of a profession solely based on the "advanced" skills. You can tell a Paramedic that you run an ECMO pump but if you say you don't intubate at that facility, they believe you are "unskilled" and a lower level. Thus, there is a lack of understanding about the depth of medicine. However, if one was to tally up the many skills of the various professions such as nursing, RRTs, SLPs, OTs and PTs, they would by far out number what a Paramedic can do. Most skills of the Paramedic can be listed in a paragraph. Even the skills of the LVN can outnumber those of a Paramedic. Nursing and RT do not always list their skills but rather they only list the exceptions for their scope of practice. The one thing RNs is learning is that their two year entry level of education is no longer adequate in the competitive world of medicine. Thus, many are going straight for the BSN and then MSN. This has been the argument with Paramedics vs RNs. When the discussion is brought up just skills are mentioned. "I can start an IV". "I can intubate". What some Paramedics don't realize is all the total patient care that goes into being an RN. Or, that RNs can intubate in most states if that is part of their job description such as for transport or L&D. We could also examine the many things that are happening with physician extenders that are rarely understood by those who have never worked with these professionals. There have been numerous discussions on EMS forums that "they don't belong" here or there but again few know their education or what potential their base educaton will lead to. If you look at their professional associations' websites, you might have an indepth look into the world of medicine and what others are doing in the name of patient care. In fact, if you look at any of the allied health professions associations' websites you will see they are actively lobbying not only for their increased professional issues but also those of the patient.

MedStar has had a couple of issues during the past year. This was one recent headline for them just a couple months ago. Unfortunately the newslink from the flight site is no loinger working. Night Vision Goggles unused for 4 years on Monday, April 20 2009 @ 09:18 Lee County MEDSTAR (FL) apparently purchased Night Vision Goggles for their helicopter 4 years ago but they have never been utilized.

Send me your photo and I'll see if there's a spot for you on the 2011 calendar. There are a couple of departments that cater to a "more mature crowd". It is actually a good seller at Wednesday Bingo.

I don't agree with letting the waitress hold the assault rifle. However, if it is for a good cause and artistic expression.... http://firefighterscalendar.com/html08/photos.html

Paid advertiser to help with the bills. You are looking at the Bachelor of Science program. It means you have to have the equivalent of two years of college with credit that is acceptable to this college. If not they have you take more classes at their prices. You need a 124 hours of credit to graduate. Yes your internship can be completed locally if there is someone willing to put you on their insurance and take the responsibility. I would find out where internships can be done in your area and get this in writing before enrolling.

Quote from the website: Have you looked at the college that is in St. Petersburg, FL that offers the same 3 degrees?

Moving forward....

Good point since only one needle size was missing. The average drug user probably could have found a market for the other sizes in his/her circle of friends.

Quote from article: If you are not near the truck or not in a position to clearly visualize it, why would you leave the truck unlocked? Especially an ambulance that some might expect to be carrying needles and drugs?

This is one of the reasons why a nurse or other licensed staff member who is familiar with a hospital goes with you. It seems you are not familiar with the workings of a hospital, Nurses know there are code carts easily within reach almost everywhere. All he/she has to do is identify a problem. There is no need to carry the equivalent of an ambulance with you from the ED to the ICU. The code team can also stabilize to the protocols of the hospital which may include many more pressors or whatever drugs that a Paramedic may not be familiar with. The team's protocols are written by their medical director who is usually a Critical Care Medicine physician. In the hospital, and in the field, the Paramedic is essentially a tech. Period. The certification does not carry enough weight with the minimal education standards to meet the requirements of a licensed professional. You don't consider sepsis "sick"? Do you know how many patients die from sepsis? Geriatric? Do you not believe any patient that lives in a nursing home has a legitimate "sickness" or can be really, really sick? There is a huge part of assessment and medicine missing in your education. If you were booksmart you would recognize this. The nurse who said you were so booksmart was probably being flirty or kind as not to know how to not offend you. Or, maybe you impressed her by reciting your protocols like memorized poetry. As long as you continue to only list skills, nurses have nothing to fear. It is the assessment portion that makes them very valuable. Paramedics are not taught the full assessment and needs of a patient inside the hospital. Your assessment in the field is to identify immediate problems. My advice to you is to learn how the hospital environment functions. It is a poor excuse to just say "they afraid of us". Know your own limitations within your own state EMS statutes. Often the way EMS wrote they statutes they use the terms prehospital only. Know the regulations required of your hospital by their accreditation agencies. Understand the professional reimbursement scales and where the hospital may be left out if an unrecognized tech performs certain skills. Learn what their liability is if their allow certain techs perform these skills. For assessment, look at the RNs paperwork. Note some of the things that were not taught in Paramedic school. Pull out the nurses P&P manual which should be at least two large volumes or an extensive list online. I would bet those Paramedics in the other hospital still function under the supervision of a nurse. Prehospital protocols do not supercede those of the hospital within the walls of a hospital. Just because you are allowed to push a certain med for something outside of the hospital does not mean that will be the appropriate pathway inside the hospital. You must understand some of the differences between prehospital and in the hospital. In the hospital you are working with known values so there would be no defense if you did as you normally do in prehospital especially if that known value would prevent you from causing harm.

Okay Ruff, tell me where I am being judgmental. I am posting off of firefly's comments. You've make some pretty damning statements in your posts with some inside information and the fact that you know the partner.

The partner should have just requested his truck go out of service before taking a patient on board instead of wasting time with the text messages. The partner should also be held accountable for allowing that truck to move with a patient on board and an unsafe driver. He should not have accepted the call. He was probably the only one in that truck thinking clearly (hopefully) and should have gotten that point across before putting another person's life at risk. If anything, he should have stopped her before any call came in and drove the truck back to the station.

No, but most ED RNs will see 20 patients in a 12 hour shift easily. You only got yelled at for one thing. Imagine working with doctors who will nit pick at the nurses for 12 hours on all of the patients. Imagine 3 patients all needing IVs and meds given at the same time ordered by the same doctor who is yelling for it to be done yesterday. Imagine ambulances coming in and your hallways are full and the rules have changed to where your ED can't divert. Imagine then also taking crap but some EMT(P) who is in a bad mood because they got pulled away from their easy chair. Our ED RNs will also work at least 3 codes during that 12 hours. We may get 8 codes in one shift with the same nurses but the patients brought in by different EMS trucks. Each of which will then hang out in the ED for an hour and talk about how bad that one code was. I thought I had it bad working on a busy rescue in a city with 26 calls in 24 hours but then I went to work in a busy hospital and saw just how good I had it with one patient at a time and being able to pack up my stuff and leave once my obligations to the patient were over. However, now that I have acquired respect for all the many professions that make up a healthcare system, I realize that EMS is just one part and although important, others are also. Working busy 48 hours shifts is horrible. If it interferes with patient care, it should be addressed. However, the 24 and 48 hour shifts are one of the perks of EMS and the FDs. If some had to go to a 40 hour work week, there would probably be only half of the employees remaining. If you want to also toss hits at mishaps and stupid incidents done by health care providers, I also work now in the ED and see how some in EMS bring their patients in. Honestly a cab would have been better since there was little to no care done even on some of the sicker patients. Worst yet I see how the NH or routine transfers are delivered. UPS takes better care of their packages than some EMT(P)s. I also was a field supervisor for EMS at one time. Between the fender benders or rollovers with the ambulances, tickets from LEOs, patient complaints and settling fights when in ED when someone felt a doctor didn't respect them, it was not a rewarding job. Yeah there horrible people that don't belong in any healthcare profession. But until you stick around in an area to actually know all the players, you truly may not know anything about their jobs. I bet some of the EMT(P)s on this forum can not name 5 healthcare professionals and their education requirements. Yet, they will cry foul when someone don't know the difference between an EMT-A-B-C-D-IV-I-P or whatever. Actually other healthcare professionals over estimate the amount of education most EMS providers have. Many believe Paramedics couldn't possibly be doing what they do without some college.

True. But how many EMS providers have been at the bedsides of two critical patients all night? However many have had to do dressing changes on wound or burn patients that you are unable to medicate down fully? How many times in one shift have EMT(P)s had to pull the plug on a baby's life support machine, comfort the family and do all the preparation of the baby for the ME? How many times have EMT(P)s been present when the person from that ATV accident is told they will never walk again? Watch them go through rehab? Drag their vent around on a wheelchair? There are a lot of healthcare profeessionals out there that don't get the recognition or respect their deserve. Most will never see a TV show or movie glamourizing their profession. A movie about OT or SLP? Not! But have many shows do we have right now good or bad showing EMT(P)s? It is really a good thing some in EMS don't have to deal with the many different healthcare professionals, managers, patients and their families that other healthcare professionals must and usually all at the same time. Yeah, and they still must try to be like a professional or some EMT(P) will get their feelings hurt if the nurse doesn't greet them just like in the movies.

He is not management. Neither are the doctors, nurses, patients, their families or anyone else that you come into contact with in healthcare. In the very short EMT or Paramedic courses there are no management classes required. Part of being a professional is being comfortable with who you are and your job title. You are also dealing with human beings under stressful situations both as patients and providers. It you do something to add more stress to the situation, you may have to expect to take a few remarks. When it comes from your medic partner it might prevent you from looking like a fool when a doctor or nurse has to correct you or snap back when you overstep your bounds. Those that complain may not see themselves as others see them. We are also only hearing one side of the story.

But that is not uncommon to hear or to even sometimes say about yourself once you know the hierarchy that exists in medicine or know your own limitations for education and protocols. You have to feel comfortable with the title you have or work to change something. That could be either getting a higher title through education or enough education to understand why you are "just an EMT" or "just a medic". Actually there are probably times when the medic may hear it more from their superiors when they are questioned why they did something or when they want to do something that is a little outside of the usual protocols. That just comes as more responsibility is added with the title and expectations can vary from those who are critiquing your work. If you are not comfortable enough to explain your actions or give the wrong impression for your reasons, you will be an easy mark for a comment such as that. It happens everyday in the world of medicine which is why other professions have continued to gain education and raise their standards.

This sounds like another EMT vs Paramedic thing. Is it possible he matured or advanced beyond some of the attitudes that exist amongst some EMTs? Did this start to happen when he discovered there was more medicine involved in EMS than what is at the BLS level?

The first step is to get providers and management to recognize there is a problem. Some may disagree with the methodology presented in this article but it has presented some data to a situation that needs attention. I do not agree with the direction Dade county has chosen as both a healthcare provider and a tax payer, but it has taken this path. Now the FD must decide whether to continue down this direction as many others have and ignor there exists a problem or deal with it head on. There are numerous articles that are both good and bad published each month in a wide variety of journals. It is nearly impossible to track all. Those published in specialty journals such as Resuscitation and Air Medical have a more favorable outcome but there are differences in that Resuscitation caters to a worldwide audience and Air Med caters to those that have closer oversight and medication assisted ETI including RSI. We could also look at the studies done on Etomindate which has over 48 articles published just recently. Unfortunately the article with the most negative presentation was reviewed in JEMS and the other studies giving different opinions were not. As well in JEMS, the author forgot to mention the researchers own opinions for limitations of the article. Thus, if you do not read the full original article, you may miss the intentions of the authors. This may be the case in this intubation article as the authors did give background in formation and a summary of limitations for the study which are not mentioned in the abstract. As far as the stretcher situation, I would agree it is time also for providers to be in better physicial shape for lifting and the training increased as well as monitored to lifting correctness. Providers were in better shape when the stretchers were one position which was the frame resting at 6 inches off the ground. The EMT(P)s actually had to be in decent physical shape to lift and hold a stance while nurses sheeted the patient over.